Background-Fractional flow reserve (FFR) specifically relates to the severity of a stenosis to the mass of tissue to be perfused. Accordingly, the larger the territory to be perfused, the greater the flow and the pressure gradient induced by maximal hyperemia. Although this notion may be considered intuitive, its unequivocal demonstration is still lacking. The aim of our study was to evaluate the influence of the amount of myocardium subtended to an intermediate stenosis on FFR, especially in relation to quantitative coronary angiography. Methods and Results-The severity of each lesion was assessed by FFR and 2-dimensional quantitative coronary angiography.The amount of jeopardized myocardium was evaluated using 3 validated scores specifically adapted to this aim: the Duke Jeopardy Score (DJS), the Myocardial Jeopardy Index (MJI), and the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Lesion Score (ALS). The presence of a concomitant collateralized chronic total occlusion was also reported. 12 We also tested the impact of proximal left anterior descending (LAD) and of a concomitant collateralized chronic total occlusion (CTO) on FFR. Methods Study PopulationAll consecutive patients undergoing physiological assessment of coronary artery disease by FFR measurement in the Department of Cardiovascular Medicine of the Agostino Gemelli Hospital at the Catholic University of the Sacred Heart in Rome, Italy, from December 2009 to September 2011 and at the Oxford Heart Center, John Radcliffe Hospital, Oxford, United kingdom, from March to September 2011 were screened. Patients presenting with diagnosed or suspected acute coronary syndrome (angina-like chest pain within the previous 24 hours with ST-T segment abnormalities and Troponin T elevation >3 times upper reference limit), with history of previous myocardial infarction (according to clinical history, ECG, or perfusion scan) in the area supplied by the target vessel or with severe left-ventricular hypertrophy were excluded. The following clinical characteristics were collected for each patient: age, sex, common cardiovascular risk factors (diabetes mellitus, active smoking, hypertension, dyslipidemia, familiarity for coronary artery disease), history of previous myocardial infarction in myocardial territory remote from that of target lesion, and indication of coronary angiography. Hypercholesterolemia, diabetes mellitus, and hypertension were considered present if they were diagnosed during hospitalization or if drugs for these conditions had been prescribed before admission. Hypercholesterolemia was diagnosed by a total serum cholesterol concentration >200 mg/dL, diabetes mellitus by fasting glycemia >126 mg/dL on >2 occasions, and hypertension by blood pressure values >140/90 on >2 occasions. Smokers were defined as smokers of >1 cigarette/d at the time of admission. Patients were defined as having a familial history of ischemic heart disease in the case of a documented acute coronary syndrome before 60 years of age in at l...

Efficacy of trans-nasal fiberendoscopic injection laryngoplasty with centrifuged autologous fat in the treatment of glottic insufficiency due to unilateral vocal fold paralysis Efficacia della laringoplastica iniettiva fibroendoscopica trans-nasale con grasso autologo centrifugato nel trattamento dell'insufficienza glottica da paralisi cordale monolaterale

cFFR is accurate in predicting the functional significance of coronary stenosis. This could allow limiting the use of adenosine to obtain FFR to a minority of stenoses with considerable savings of time and costs.

CMR is accurate in predicting the functional significance of coronary stenosis. This could allow limiting the use of adenosine to obtain FFR to doubtful cases. In particular, we suggest considering a CMR value ≤0.83 to be significant, a CMR value ≥0.88 as not significant, and inducing maximal hyperaemia using adenosine for FFR assessment when CMR is between 0.84 and 0.87.